AMC MCQ - Australian Medical Council Multiple Choice Questions Ethics and Professional Practice Questions and Answers 1 — Questions and Answers
Question 1: An 82-year-old man with metastatic lung cancer and a valid Advance Care Directive (ACD) is admitted with sepsis from a urinary tract infection. The ACD clearly states he refuses all life-sustaining treatments, including intravenous antibiotics and admission to an intensive care unit. The patient is now delirious and lacks decision-making capacity. His family is adamant that he should receive antibiotics, stating, "He wouldn't want to die from a simple infection." What is the most appropriate and legally defensible course of action for the treating doctor?
- Follow the family's wishes and commence intravenous antibiotics.
- Seek an urgent ethics committee review before making a decision.
- Uphold the patient's refusal of treatment as stated in the valid ACD. (Correct answer)
- Provide palliative care but administer antibiotics for comfort.
Correct answer: Uphold the patient's refusal of treatment as stated in the valid ACD.
In Australia, a valid and specific Advance Care Directive (ACD) is a legally binding document that represents the patient's wishes. When a patient loses decision-making capacity, the instructions in the ACD must be followed, even if they conflict with the wishes of the family or the treating team's clinical judgment about what might be 'best'. The refusal of IV antibiotics is a specific instruction for a life-sustaining treatment, which must be respected. Seeking an ethics review is a good step in complex cases but does not override the legal standing of the ACD. Administering antibiotics against a valid refusal would constitute medical battery.
Question 2: A junior doctor notices that a senior surgical consultant frequently appears to have tremors and slurred speech during morning rounds, particularly on Mondays. The junior doctor smells alcohol on the consultant's breath on one occasion. When privately asked, the consultant dismisses it as fatigue. According to the Health Practitioner Regulation National Law, what is the junior doctor's primary professional obligation?
- Discuss the concerns with other junior doctors to see if they have noticed similar behaviour.
- Advise the consultant to self-report to the Medical Board of Australia.
- Directly report the concerns to the hospital's Director of Medical Services.
- Make a mandatory report to the Australian Health Practitioner Regulation Agency (AHPRA) about potential notifiable conduct. (Correct answer)
Correct answer: Make a mandatory report to the Australian Health Practitioner Regulation Agency (AHPRA) about potential notifiable conduct.
The scenario describes a reasonable belief that a practitioner may be practising while intoxicated, which falls under the definition of 'notifiable conduct' in the National Law. All registered health practitioners have a legal obligation to report notifiable conduct to AHPRA to protect the public from harm. While discussing with a hospital manager (DMS) is a reasonable step, it does not absolve the practitioner of their personal mandatory reporting obligation. Discussing with peers is inappropriate and advising the consultant to self-report does not fulfil the observer's duty.
Question 3: A 75-year-old patient with early-stage dementia requires an elective cholecystectomy. While she understands she has gallstones, she has difficulty retaining information about the risks and benefits of the surgery for more than a few minutes. Her son, who is her appointed enduring power of attorney for medical decisions, provides consent. Which of the following principles is most critical for the surgeon to have addressed BEFORE proceeding with the son's consent?
- That the son has a good relationship with his mother.
- That the patient has been formally assessed as lacking capacity for this specific decision. (Correct answer)
- That a second surgical opinion has been obtained.
- That all non-surgical options have been trialled and failed.
Correct answer: That the patient has been formally assessed as lacking capacity for this specific decision.
The presumption in Australian law is that all adults have decision-making capacity. This capacity is decision-specific. Before a substitute decision-maker (like a son with an enduring power of attorney) can be relied upon, the patient must be formally and reasonably assessed as lacking the capacity to make that particular medical decision at that time. The assessment involves determining if the patient can understand, retain, weigh, and communicate a decision. The other options, while potentially part of good practice, are not the essential prerequisite for activating the power of attorney.
Question 4: During a surgical procedure, a swab is inadvertently left inside a patient's abdomen. The error is discovered on a post-operative X-ray the next day, and the patient requires a second procedure for its removal. The patient makes a full recovery. According to the Australian Open Disclosure Framework, which of the following is an essential and early component of the open disclosure process with the patient?
- A detailed explanation of the root cause analysis findings.
- Providing the patient with the names of all staff involved in the initial surgery.
- An apology or expression of regret for the harm that occurred. (Correct answer)
- Assurance that the hospital's legal team accepts full liability.
Correct answer: An apology or expression of regret for the harm that occurred.
The Australian Open Disclosure Framework is a nationally consistent approach to communicating with patients after an adverse event. A core principle is an early and sincere apology or expression of regret (e.g., "we are sorry") for the harm suffered by the patient. This should be done alongside a factual explanation of what happened. While a root cause analysis is important for systems improvement, its detailed findings come later. Disclosing staff names may not be appropriate, and discussions of legal liability are separate from the initial open disclosure process.
Question 5: A GP has been treating a patient for several years. The patient sends the GP a 'friend request' on a personal social media account. The GP's profile contains photos of their family and social activities. According to the Medical Board of Australia's Code of Conduct and guidelines on professional boundaries, what is the most appropriate response?
- Accept the request but change privacy settings to limit what the patient can see.
- Politely decline the request, explaining the need to maintain a professional doctor-patient relationship. (Correct answer)
- Ignore the request and do not mention it at the next consultation.
- Accept the request, as declining could damage the therapeutic relationship.
Correct answer: Politely decline the request, explaining the need to maintain a professional doctor-patient relationship.
The Medical Board of Australia's 'Good Medical Practice: A Code of Conduct for Doctors in Australia' requires doctors to maintain professional boundaries. Interacting with current patients on personal social media blurs these boundaries and is strongly discouraged. The most appropriate action is to politely decline and, if necessary, explain that this is standard professional practice to keep the doctor-patient relationship clear and therapeutic. Accepting, even with modified privacy settings, can still lead to boundary violations.
Question 6: A 15-year-old girl attends a GP appointment alone and requests contraception. She is assessed to be a 'Gillick-competent' minor, meaning she has sufficient understanding and intelligence to comprehend the nature and implications of the proposed treatment. Her parents are unaware of the appointment. Which of the following is the most ethically and legally sound action for the GP?
- Refuse to prescribe until parental consent is obtained.
- Prescribe the contraception as the patient's confidentiality takes precedence. (Correct answer)
- Contact the parents to inform them of their daughter's request.
- Agree to prescribe only if the patient agrees to inform her parents within one month.
Correct answer: Prescribe the contraception as the patient's confidentiality takes precedence.
In Australia, the principle of 'Gillick competence' (derived from UK common law and accepted in Australia) allows a minor who has sufficient maturity and intelligence to understand the proposed treatment to consent to it without parental knowledge or consent. In this situation, the duty of confidentiality owed to the competent minor patient is paramount. Prescribing contraception is appropriate. Breaching the patient's confidentiality by contacting the parents would be inappropriate and illegal, and making treatment conditional on her telling her parents undermines her autonomy and right to confidential medical care.
AMC MCQ - Australian Medical Council Multiple Choice Questions Ethics and Professional Practice Questions and Answers 1
An 82-year-old man with metastatic lung cancer and a valid Advance Care Directive (ACD) is admitted with sepsis from a urinary tract infection.
The ACD clearly states he refuses all life-sustaining treatments, including intravenous antibiotics and admission to an intensive care unit.
The patient is now delirious and lacks decision-making capacity.
His family is adamant that he should receive antibiotics, stating, "He wouldn't want to die from a simple infection." What is the most appropriate and legally defensible course of action for the treating doctor?